Menstruation is experienced by many athletes who participate in sport, yet it is a topic that is still considered “taboo” and rarely addressed in sport, academic, or broader public discourse. Low levels of coach knowledge regarding menstruation in sport can hinder athlete-coach communication (Höök et al., 2021), and coaches have voiced interest in trying to understand how to communicate with athletes about their menstrual cycle and associated symptoms (Clarke et al., 2021). The objective of our program of research is to identify necessary components for developing evidence-based practices and guidelines to support athletes who menstruate. The specific purpose of this study was to describe coaches’ experiences of working with athletes who menstruate. Participants included 15 high-performance coaches (11 women, 4 men) involved at national and international levels in a variety of winter and summer sports. Using a qualitative description study design, participants engaged in one-on-one semi-structured interviews via Zoom. Interviews were audio-recorded, transcribed verbatim, and analyzed using a process of content analysis as described by Elo and Kyngäs (2008). The findings of this study are represented by one overarching theme: managing athletes’ menstruation experiences, and four main themes: (a) understanding symptoms and contraceptives, (b) normalizing conversations, (c) establishing coaching education, and (d) creating change. The complex and diverse experiences shared by participants highlight the importance of studying menstruation within the sport context. Findings from this research may help to inform the development and implementation of sport practices and guidelines that support menstruating athletes.