This paper maps the knowledge, attitudes, beliefs and practices surrounding menarche, menstrual hygiene and menstrual health among adolescent girls in low and middle income countries in order to inform the future design of relevant policies and programming. The study of over 80 journal articles from a number of low and middle income countries confirmed that: (1) Many adolescent girls start their periods uninformed and unprepared. (2) Mothers are the primary source of information, but they inform girls too-little and too-late and often communicate their own misconceptions. (3) Because menstruation is widely seen as polluting and shameful, girls are often excluded and shamed in their homes and in their communities. (4) Many do not have the means for self-care and do not get the support they need when they face problems, which hinders their ability to carry on with everyday activities and may also establish a foundation for life-long disempowerment. Efforts to respond to girls’ needs are fragmented and piece-meal. There is growing acknowledgement that efforts are more likely to be successful if they come together in a whole-of-community approach that involves schools, health facilities, and homes and communities to: (1) Educate girls about menstruation. (2) Create norms that see menstruation as healthy and positive, not shameful and dirty. (3) Improve access to sanitary products, running water, functional toilets and privacy for self-care. (4) Improve care for and support by girls’ families when they have their periods. (5) Improve access to competent and caring health workers when they experience menstrual health problems.