Good menstrual hygiene management in schools means that schoolgirls have access to adequate school toilets that meet criteria for basic sanitation and hygiene service, but also that they have basic knowledge about menstrual hygiene. The aim of this work is to assess sanitation and hygiene conditions for adequate menstrual hygiene management in rural schools in the Šumadija and Pomoravlje districts. The study was conducted on the territory of the rural areas of Šumadija and Pomoravlje districts in 2016. It encompassed 238 schools, of which 108 in Šumadija and 130 in Pomoravlje district. To assess sanitation and hygiene conditions for adequate menstrual hygiene management, a questionnaire was created, with questions related to: existence of toilets at schools and whether they are functional, accessible, single-sex, and ensure privacy, to provision of soap and toilet paper, handwashing facilities, bins with a lid in toilet cubicles for schoolgirls, and to provision of menstrual hygiene education. This research showed that a high percentage of school toilets in rural areas meet the basic service criteria (more than 90% for sanitation and about 85% for hygiene) in respect of toilet type and whether toilets are single-sex, usable, and with functional handwashing facilities. However, the obstacles to reaching the criteria for advanced service level are the insufficient provision of facilities for the disposal of menstrual products in toilet cubicles (76.9%), as well as the absence of menstrual hygiene education in 50% of schools. The research indicated the need to improve sanitation and hygiene conditions in order to reach advanced service level that would include better menstrual hygiene management in rural schools in Serbia. Also, a continued research should be focused on the role of social and economic aspects concerning schoolgirls and their families in the attainment of adequate menstrual hygiene.