Menstrual Hygiene Management (MHM) is a critical public health issue that profoundly impacts women’s reproductive health, educational attainment, and labor participation, with far-reaching implications for gender equality and women’s empowerment in Bangladesh. Poor MHM practices, such as the use of unhygienic materials like old cloth, are associated with increased risks of reproductive tract infections (RTIs) and urinary tract infections (UTIs), which disproportionately affect vulnerable populations, particularly women and girls in rural and peri-urban areas. While existing academic studies have primarily focused on adolescent girls in school settings, middle-aged women in these regions remain an underserved group, facing unique challenges due to poverty, lack of awareness, and infrastructural constraints. Previous studies, including a 2014 school-based intervention, have highlighted the pervasive cultural taboos, lack of awareness, and use of unhygienic materials like old cloth among adolescent girls, leading to increased school absenteeism and health complications such as urinary and reproductive tract infections. In 2017, a comprehensive survey was conducted across six districts in Bangladesh (Rangpur, Shatkhira, Feni, Khulna, Gazipur, and Tangail) to assess MHM practices among 300 women and adolescents aged 12–50 years. The findings revealed that 56% of respondents used sanitary pads, while 41% relied on cloth and 3% used cotton, indicating that 44% were not practicing proper MHM. Key barriers to sanitary pad usage included high cost (51%), lack of accessibility (19%), and a preference for traditional methods (30%). Additionally, the survey explored the frequency of changing sanitary pads, finding that 22% changed pads once a day, 48% changed twice a day, and 29% changed three or more times a day—practices that fall short of hygiene guidelines recommending changes every 2–6 hours. These findings challenged the results of the 2014 National Hygiene Survey, which reported 86% cloth usage and only 10% sanitary pad usage. A follow-up survey in 2018 corroborated the 2017 results, showing 55% cloth usage, 43% sanitary pad usage, and 1.6% cotton usage, further validating the need for targeted interventions. To address these barriers, a multi-faceted approach was implemented, combining mass media campaigns, ICT-based interventions, and grassroots health worker training to dismantle cultural taboos and improve awareness about MHM. Simultaneously, advocacy efforts were directed at reducing the high cost of sanitary napkins, which ranged from 10–18 BDT per piece due to exorbitant customs duties—127.48% on finished products and 70% on imported raw materials. After 1.5 years of sustained activism, the government responded by reducing customs duties on raw materials and finished products to 25% on June 30, 2019. Additionally, sanitary napkins were made freely available to adolescent girls through government health centers, and training programs were initiated for grassroots