Menstruation is a taboo subject in the Indian context and considers it as unclean where socio-cultural restrictions keep girls and women ignorant of the scientific facts and hygienic practices that result in adverse health outcomes. This study has assessed the knowledge, practices, and perceptions of the adolescent girls both in rural and urban and compared the same. This is a cross-sectional study that has been conducted among 309school going adolescent girls who were selected randomly from the selected schools at Karur District, Tamil Nadu covering both rural and urban. A structured questionnaire was used to collect the data. Data obtained was compiled and analyzed using the SPSS version 22. This study shows that urban adolescent girls have better knowledge regarding menstrual hygiene than rural adolescent girls. But most of the negative perceptions found to be similar among both rural and urban girls. However, there is a change in perceptions in certain aspects among urban girls than rural girls. Majority of the respondents (88%) are using sanitary pads at the time of menstruation and only 12% of respondents use cloths which is a good indicator for hygienic practice. However, the frequency of changing pad is more important hygienic practice. One-fifth of the girls do not practice it which is found to be more among the rural girls compared to the urban girls. The findings on the knowledge, practices, and perceptions among the adolescent girls show that rural girls need more information /facts on menstruation compared to urban girls. It is the need of the hour that we need to integrate all the stakeholders viz the health, education and community professionals both private and state to work together for the promotion of menstrual hygiene management among adolescent girls.