Objectives – This study reassesses the dominant “pad deficit” explanation for period-related school absenteeism in Ghana by identifying the key factors driving girls' absence during menstruation and assessing perceptions of parents and teachers on the national free sanitary pad policy. Methods – A mixed-methods approach was employed, combining survey data from over 1, 300 adolescent school girls with focus group discussions involving teachers and parents. Descriptive statistics and a supplementary ordered logistic regression model were used to analyze the relative importance and independent effects of reported constraints, while thematic analysis was used to assess the views of stakeholders on period-related school absenteeism. Results – Among school girls, menstrual discomfort emerged as the most frequently cited reason for absenteeism, followed by inadequate sanitation conditions and limited access to sanitary products, while teachers and parents most frequently attributed absenteeism to sanitary pad deficit. Supplementary regression results confirm that menstrual discomfort outweighs the effects of pad access, WASH infrastructure, and social factors. Stakeholder perceptions suggest that the free pad initiative addresses only part of the problem. Conclusion – Findings challenge the dominant sanitary pad deficit explanations of period-related absenteeism among school girls in low-income settings, and highlight the need for an integrated, ecosystem-based response that prioritizes biological, material, infrastructural, and socio-cultural constraints to addressing period-related absenteeism among school girls. The study accordingly reconceptualizes period-related absenteeism by positioning menstrual discomfort, rather than material access, as the central predictor of school absence.