Building upon Lahiri-Dutt’s (2015) critique of Menstrual Hygiene Management (MHM) initiatives, this paper explores four ways of ‘knowing’ menstruation to draw out the continuities and patterns of knowledge-making and unmaking in regard to the menstruating body. It engages with paradigms of menstruation advanced by colonial doctors, Hindu reformers, early twentieth century Ayurvedic practitioners, and contemporary public health researchers, reading these alongside personal accounts by contemporary slum-dwelling women and girls. Across these very different contexts, the paper shows how the complex epistemic terrains of menstruation in India are particularly attuned not only to the ways knowledge is produced, but also to the ways in which varied forms of knowledge position bodies, cultures, and practices as different—and often deficient—in relation to a shifting set of codes signifying civilization, development, empowerment, or culture. The paper demonstrates the ways in which menstruation is rendered a technical hygiene crisis by the development industry that declares women’s knowledge of their own bodies as incomplete and inadequate. Yet, instead of a simplistic teleology of knowledge as development, or experience as a ‘pure’ source of knowledge, by exploring ‘different knowledges’ this paper illustrates how both difference and knowledge are produced in multiple ways in different contexts of knowing.