Background <p>Menstruation is a subject that is not discussed enough, especially in many developing countries. Despite being a physiological event and an essential aspect of girls’ reproductive health, it is surrounded by myths, misconceptions, and beliefs that negatively influence the overall experience of the process. Therefore, the aim of this study is to explore the knowledge, perceptions, and practices of menstrual hygiene in selected region in Kwara State, Nigeria.</p> Methodology <p>An analytical cross-sectional study was conducted among 154 adolescent girls aged 10–19 years in selected secondary schools, Ilorin West, Nigeria. The sample size was determined using Fisher’s formula for single proportions. Participants were selected through multi-stage sampling technique, and data were collected using a facilitated self-administered questionnaire.</p> Result <p>A significant percentage (93.5%) had heard about the subject before menarche mostly from their mothers (69.9%). Many respondents, 53.9% had good knowledge of menstruation and menstrual hygiene. Majority, 82.5% combined other materials with sanitary pads, but ultimately, 53.2% had good practice. Among the methods of disposal of absorbents, toilet disposal was the most employed (54.2%), followed by dustbin (22.9%) and underground burying (17.6%). The major barriers to proper practice of menstrual hygiene identified were inadequate funds and inflexible class schedules that prevent respondents from attending to their menstrual hygiene needs. Majority, 61.5% of girls with good knowledge of menstruation and menstrual hygiene maintain good hygiene practice while 43.7% of girls with poor knowledge maintain good hygiene. There is a statistically significant association between overall level of knowledge and menstrual hygiene practices (<i>p</i> &lt; 0.05).</p> Conclusion <p>Menstrual hygiene practices vary significantly according to the level of knowledge. Girls with good knowledge are more likely to maintain good hygiene than those with poor knowledge.</p>