The purposes of this study were to assess menstrual attitudes and menstrual distress and investigate factors associated with menstrual distress among postmenarcheal female elementary students. A total of 129 female students from 12 elementary schools in Taiwan's Hualien County participated in this study. A stratified cluster random sampling method was adopted. The questionnaire used consisted of three sections asking questions regarding the individual's menstrual characteristics, menstrual attitudes, and menstrual distress. Study results showed that most respondents experienced menstrual blood seepage during the daytime and awakened at night during their periods due to worries about menstrual blood seepage. This study found that indigenous students had significantly more frequent episodes of menstrual blood seepage during the daytime and awakened at night during period than did nonindigenous students. The mean score on the Menstrual Attitude Questionnaire was 1.88 (SD = 0.36, possible score = 1-4). The three most prevalent symptoms of menstrual distress were dysmenorrhea, acne, and fatigue. The mean score on the Menstrual Distress Questionnaire was 1.00 (SD = 0.76; possible score = 0-4). Moreover, there was a significantly negative correlation between menstrual attitudes and menstrual distress and significantly positive correlations between menstrual distress and (a) time since menarche, (b) menstrual blood seepage during the daytime, and (c) menstrual blood seepage while sleeping. Study results recommend that families and elementary schools help postmenarcheal female elementary students to accept menstruation as a natural process.