The importance of girls' education for population health outcomes in low-income countries is well documented. Despite this critical relationship, the global public health community has tended to overlook aspects of the school environment that may hinder girls' pubertal transitions in schools across low-income countries. Minimal empirical attention has been given to structural and environmental factors, both physical and social, within the school experience that may impact on pubescent and newly menstruating girls' school attendance and participation and, ultimately, their health and well-being. This article describes an in-depth study conducted in Kilimanjaro, Tanzania that explored post-pubescent girls' experiences of managing their menstrual flow in school environments. The study identified eight fundamental structural and environmental factors impacting on girls' school-going experiences, such as insufficient water and sanitation and the disciplinary nature of the academic atmosphere. The public health and education fields are long overdue to collectively address these pubertal-related challenges facing schoolgirls in low-income countries.