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Menstrual Health and Hygiene (MHH) require adequate sanitary facilities, clean water, product access, privacy and safety, and disposal. MHH can significantly influence girls' health and educational achievements. However, schools in some developing countries lack proper Water, Sanitation and Hygiene (WASH) amenities to manage healthy menstruation. Therefore, it is crucial to enhance WASH services to tackle menstrual-related difficulties effectively. Zambian government schools struggle with insufficient WASH infrastructures. Hence, it is imperative to reveal the status of WASH services for policy progress and to promote girls' optimal menstrual health. We conducted observations and a qualitative study to evaluate the school's WASH facilities, investigate the sociocultural factors impacting MHH, and examine coping mechanisms to manage menstruation. Thirty adolescent schoolgirls, aged 14–19, residing in Lusaka peri-urban areas, participated in five focus group discussions. Insufficient school security, inadequate sanitary facilities, absence of clean water, and limited access to menstrual materials presented notable challenges. Culturally, there was an expectation for girls to swiftly embrace womanhood despite being unprepared for the natural biological process it entailed. Girls formulated strategies for managing challenges associated with MHH. The fundamental needs of menstruating girls include a sufficient supply of menstrual materials, improved WASH services, increased safety, and enhanced privacy.