Purpose: The purpose of this study was to examine factors related to attitudes to menstruation in elementary school girls according to menarche experience. Methods: Data were collected using a structured questionnaire from 208 girls in 5th or 6th grade (90 who were menarche and 118 who were not). The study was a cross-sectional study. Data were analyzed using SPSS/WIN 18.0 program for descriptive statistics, t-test, ANOVA, Pearson correlation, and multiple regression. Results: There were significant differences in body image, menstrual knowledge and attitude between the two groups of students. Results from the multiple regression analysis revealed difference in related factors and in the magnitude of the relationship evaluated by standardized beta coefficients. Significant factors, listed by the magnitude of beta coefficients, among students in menarche were positive affect of menarche, self-oriented perfectionism-critical, negative affect of menarche. Significant factors among non-menarche students were menstrual knowledge and self-oriented perfectionism-critical. Conclusion: There are differences between menarche and non-menarche girls in attitude to menstruation and related factors. Based on the results of the present study, systemic health education according to differences between the two groups should be developed to foster positive attitudes to menstruation.