In total, women spend around six to seven years of their lives menstruating. A key priority for women and girls is to have the necessary knowledge, facilities and cultural environment to manage menstruation hygienically, and with dignity. Yet the importance of menstrual hygiene management is mostly neglected by development practitioners within the WASH (water, sanitation and hygiene) sector, and other related sectors such as reproductive health. This article explores the reasons why menstrual hygiene management is not generally included in WASH initiatives, the social and health impacts of this neglect on women and girls, and provides examples of successful approaches to tackling menstrual hygiene in WASH in the South Asia region.