The rapid urbanization and development of megacities across many low- and middle-income countries creates new challenges in global health; this is particularly true for women and girls who are disproportionately affected by poor urban planning, inadequate sanitation infrastructure, and limited access to water. Urban slums serve to reinforce many gendered inequalities, as reflected in poor sexual and reproductive health outcomes and various other health and wellbeing indicators. Women and adolescent girls in urban slums are particularly vulnerable in relation to their experiences of menstruation, given the limited access they may have to safe, private spaces with water for changing, washing, bathing, and laundering reusable pads, menstrual cloths and pads, and insufficient access to culturally acceptable, adequate disposal mechanisms for used menstrual materials. On-going taboos and stigma around menstruation likely augment these challenges in urban slum contexts; however, there exists limited literature on the intersection of menstrual hygiene management with water and sanitation systems in urban slums in low- and middle-income countries. Through a review of literature, this article seeks to highlight critical interlinkages between urbanization, sanitation, and menstruation, and identify important gaps in the existing menstruation-related evidence base that have implications for the health and wellbeing of adolescent girls and women.