The barriers to menstrual hygiene management faced by adolescent schoolgirls in low-income countries are gaining interest at practice and policy levels. The challenges include inadequate water, sanitation and disposal facilities for the management of menses with privacy and dignity, and insufficient guidance to help girls feel confident in attending school during menses. The studies described here aimed to examine how menarche impacts the lives of schoolgirls in three low-income countries (Ghana, Cambodia and Ethiopia). The focus included girls’ school participation; their relationship with parents, teachers and peers; their evolving sanitation and hygiene needs; their understanding of cultural issues and taboos around menses; and what education, if any, they received prior to and during puberty. This comparative analysis was aimed at identifying similarities between the three countries that would enable the adaptation to each context of a training book on menstruation issues for girls, which was developed from a previous study conducted in Tanzania. In all three countries, participatory activities were utilised with girls and results were analysed using grounded theory. Findings included: similarities regarding the importance of culture in perpetuating negative attitudes towards menstruation, limited provision of health information and insufficient facilities within schools. Differences were revealed regarding menstrual myths, parent–child dynamics, sources of guidance and student–teacher relations. There is a critical knowledge gap around menstruation and girls’ education in these contexts that must be addressed to ensure that girls experience a positive menarche and can manage menstrual hygiene.