Menstrual hygiene remains critically overlooked for adolescent girls with intellectual disabilities, despite its profound health and human rights implications. This State-of-the-Art review synthesises global and Indian literature to explore the biological, psychosocial, cultural, and policy dimensions of menstrual experiences in the population. Evidence shows delayed menarche, irregular cycles, poor self-care and high caregiver dependence compounded by cognitive deficits, communication challenges, and behavioural problems. Caregivers, mainly mothers in the Indian context, face significant stress, stigma and lack of training. Cultural taboos and disability stigma create a ‘Double Silence’ often resulting in school exclusion or non-therapeutic hysterectomy. This state-of-the-art review discusses six major themes: sexuality and vulnerability, medicalisation dilemmas, mental health, policy and rights gaps, the triple burden of gender-poverty-disability and pedagogical approaches. While promising practices such as visual pedagogy, simulation training and caregiver education exist, disability-inclusive policies and interventions remain inadequate. This calls for urgent reforms to promote dignity, autonomy and equitable menstrual health for adolescents with intellectual disabilities.