While the sanitation sector is gaining increased recognition in policy and research, its inherent inter-linkage with menstrual hygiene management remains an under-researched subject. This review explores knowledge about menstrual beliefs and behaviors, and how women and girls currently handle their monthly menses in relation to existing sanitation systems in low-income countries. It further explores how used menstrual materials are disposed of, and the consequences of different disposal practices for the functioning of sanitation systems. Conclusions point towards the inadequacy of research in the area of menstrual management. The lack of privacy and space for changing, cleaning, drying or discarding materials, as well as insufficient availability of water for personal hygiene stand out as important areas where sanitation systems often fail to cater to the needs of menstruating girls and women. Information on proper disposal of menstrual materials as well as the actual provision of disposal facilities are important for improving menstrual management and ensuring that absorption materials do not impair the functioning of sanitation systems. Training of sanitation system designers and planners with regard to menstrual management could lead to sanitation systems becoming more inclusive of the full needs of all people.