The research paper examines the problems related to menarche and menstruation at the bottom of the pyramid in India. The purpose of the research is to promote menstrual health management (MHM) at the bottom of the pyramid to promote well-being of girls and women and to reduce absenteeism and drop-out rates in schools in rural India. India scores lowest in sanitary napkin usage in the world. Lack of awareness and education regarding menarche contributes to anxiety, fear and abuse among young girls. Commercial products like sanitary pads, tampons and menstrual cups are less widely available and often unaffordable. Due to poor menstrual hygiene practices more than 70% of women are diagnosed with serious vaginal and urinary tract infections each year. There is urgent need for Government, NGO’s and corporates to collaborate together to provide affordable and sustainable menstrual hygiene management solutions for the welfare of the community at large.