Background: Menstrual hygiene has been an issue since antiquity and recently gained some attention. Nevertheless, it is hindered by taboos, myths, and restrictions surrounding it in some rural and urban areas of Central India. Adolescent girls often lack knowledge about practices regarding menstruation, thus affecting their overall health and development. There are discrepancies in the data among pubescent girls in urban and rural India. Objective: The objective is to assess and compare knowledge, perceptions, taboos, and practices among adolescent girls about menstrual hygiene. Methodology: In the Wardha district's urban and rural regions, a cross-sectional study was undertaken at schools. A total of 400 girls were selected as study participants between the age group range of 12–16 years by random selection. Data were collected with the help of a semi-structured pre-tested questionnaire. Girls were motivated to complete the questionnaire without any additional information on the subject of interest. Results: The mean age of our study participants was 15 years, and the mean age of menarches among them was 13 years. We found that around 5% of adolescent girls from rural and urban areas still believe menstruation is linked to God's blessing/curse. A significant portion (18%) of rural girls use just cloth compared to nil cloth usage in urban areas. Conclusion: While there is a need for improving knowledge about menstruation among urban and rural students, the lack of knowledge is greater in rural areas, and students from rural areas are more distressed during their periods.