First-year nursing students often face high stress and challenges in adjusting to academic and social demands, which can negatively affect their psychologi

Background: Menstrual hygiene management (MHM) is a vital aspect of adolescent girls’ health and well-being. However, in many Gulf countries, including Saudi Arabia, this issue has received less attention because of cultural taboos, misconceptions, and a lack of knowledge about factors affecting menstrual hygiene practices. Thus, it is crucial to promote adolescent health and develop effective school-based interventions. Aim of the Study: Our aim was to assess menstrual hygiene practices and their determinants among adolescent girls in secondary schools in Bisha, Saudi Arabia. Methods: A cross-sectional descriptive approach was used to study 320 female secondary school students in Bisha City, southwestern Saudi Arabia. Sample: The subjects were selected by using a stratified random sampling procedure. Information was obtained using a previously validated and culturally sensitive self-administered questionnaire on knowledge and menstrual hygiene. Descriptive statistics, chi-square tests, and binary logistic regression analyses were conducted to determine factors associated with good menstrual hygiene practices. Results: A total of 320 adolescent girls participated, of whom 53.8% demonstrated good menstrual hygiene practices. In the multivariable analysis, independent predictors of good practices were increased age (AOR = 2.69, 95% CI:1.59–4.56), urban residency (AOR = 2.62, 95% CI: 1.46–4.69), and good menstrual knowledge (AOR = 2.13, 95%CI: 1.24–3.67). Maternal primary education (AOR = 8.033, CI: 1.44–44.99) and maternal employment in the government sector (AOR = 7.346, CI: 2.29–23.54) also showed strong positive associations with good menstrual hygiene practices. Conversely, experiencing menarche after age 12 was associated with lower odds of good menstrual hygiene (AOR = 0.49). Conclusions: Although a good proportion of girls practiced adequate menstrual hygiene, major knowledge and behavior gaps persist. Providing strong menstrual education in schools and through community-based efforts is critical for supporting the health of adolescent girls and promoting menstrual equity in Saudi Arabia.