Menstrual hygiene management (MHM) remains a critical yet overlooked challenge in resource-poor countries, disproportionately affecting adolescent girls’ health, education, and empowerment. This review synthesizes evidence from sub-Saharan Africa and South Asia, revealing that over 50% of girls miss school monthly due to inadequate MHM resources, such as sanitary products and private WASH facilities. Many rely on unsafe materials like cloths or leaves, correlating with a 65% higher risk of urogenital infections compared to sanitary pad users. School absenteeism is exacerbated by stigma, lack of teacher support, and poor infrastructure (e.g., 54% of Indian girls avoid school during menstruation). Interventions distributing pads or reusable products (e.g., Ghana’s 3-arm trial) reduced absenteeism, though cultural resistance and affordability persist. The review underscores systemic barriers—male-dominated decision-making, economic constraints, and fragmented WASH policies—while advocating for multi-sectoral solutions, including education, product access, and infrastructure upgrades. Future research must address gaps in understanding household decision-making, long-term health impacts, and integration of MHM into global health agendas.