Monsterhearts is set in a fictional high school that along with the surrounding environment is named and fleshed out by all players during character creation.

This is explicitly because as a teenager you don't get to choose what turns you on, and because "Monsterhearts is a game about the confusion that arises when your body and your social world start changing without your permission.

It also doesn't slut-shame, or enforce traditional gendered tropes of judgment about sexual behavior.

Hot can be used to "turn someone on" or (in the first edition) "manipulate an NPC", cold to "shut someone down" or to keep one's nerve and "hold steady", volatile to "lash out physically" or run away", and dark to "Gaze Into The Abyss" and for most skin-specific magical functions.

Playtesting took most of 2011, with the first edition being launched through Indiegogo in January and February 2012[5] as a 160-page softcover book with cover art by Konradbak.

Beth Elderkin reviewed Monsterhearts in 2020 as part of a list of romantic tabletop role-playing games, saying that "It's a great game for those wanting to go back to the days of young crushes, backseat make-out sessions, and all the tension around whether you should 'do it' at monster prom.

Horvath concluded, "Monsterhearts is an important gateway and it represents a massive step forward to diversifying the hobby.