Menstrual health management (MHM) reflects a complex interaction of educational, socio-cultural, economic, and environmental influences. While various aspects of MHM have been explored in previous studies, little attention has been given to how these factors differ across generations. This study examines generational variations in MHM among Indonesian women, focusing on Millennials (born 1981–1996) and Generation Z (born 1997–2012). Using a quantitative survey involving 334 participants, consisting of 171 Millennials and 163 Gen Z participants, the study investigates attitudes, practices, and behaviors related to MHM. Results show broad similarities between the two cohorts, alongside notable differences in three areas: monthly spending on menstrual products, adequacy of initial menstrual education, and use of environmentally friendly menstrual products. Millennials reported higher spending and greater engagement to sustainable products, likely due to stronger financial stability, whereas Gen Z participants demonstrated better early menstrual education and digital information access. The study highlights the need for inclusive and generation-responsive menstrual health programs that represent Indonesia’s diverse cultural and socio-economic contexts.