The Macho River originates at the southern limit of the Eeyou Istchee James Bay (municipality) administrative region in a large swamp area. Its course begins with a widening of the river (elevation: 390 metres (1,280 ft)), located at 0.4 kilometres (0.25 mi) south-east of the Panache River which sinks to the southwest, to discharge on the north bank of the Wetetnagami River.

This source of the river is located at:

• 0.9 kilometres (0.56 mi) south-east of route 105B going up to the northeast [Panache River];
• 60.8 kilometres (37.8 mi) north of the confluence of the Macho River with Berthelot Lake (Mégiscane River);
• 132.8 kilometres (82.5 mi) north-east of downtown Senneterre;
• 73.7 kilometres (45.8 mi) northwest of the village center of Obedjiwan;
• 93.0 kilometres (57.8 mi) north of the Canadian National Railway.

The main hydrographic slopes near the Macho River are:

• North side: Panache River, Fortier River;
• east side: Barry Lake (Saint-Cyr River South), Saint-Cyr River South, Saint-Cyr Lake (Saint-Cyr River South), Mégiscane Lake, Mégiscane River;
• South side: Mégiscane River, Berthelot lake;
• West side: Wetetnagami River, Saint-Père River, Wetetnagami Lake, Achepabanca River, Achepabanca River Northeast.

From its source, the Macho River flows over 69.6 kilometres (43.2 mi) according to the following segments:

Upper Macho River (segment of 46.7 kilometres (29.0 mi))

• 9.8 kilometres (6.1 mi) to the south surrounded by marsh areas, and enters the administrative region of Abitibi-Témiscamingue, to the north shore of Loutres Lake;
• 7.7 kilometres (4.8 mi) southerly crossing Loutres Lake (elevation: 387 metres (1,270 ft)) to its mouth on the west shore;
• 10.9 kilometres (6.8 mi) southwesterly through marsh areas on each side of the river to the north shore of Maseres Lake;
• 18.3 kilometres (11.4 mi) southerly, crossing Maseres Lake (elevation: 385 metres (1,263 ft)) to its mouth;

Lower Macho River (segment of 26.0 kilometres (16.2 mi))

• 5.6 kilometres (3.5 mi) southerly, including crossing the unidentified lake (elevation: 385 metres (1,263 ft)) consisting of a widening of the river to its mouth;
• 7.2 kilometres (4.5 mi) southwesterly, then south, to the north shore of Maricourt Lake (Macho River);
• 6.9 kilometres (4.3 mi) southerly crossing the northern portion of Maricourt Lake (Macho River) (elevation: 385 metres (1,263 ft)) along its entire length, to a straight line formed by the reconciliation of two opposite peninsulas. Note: The Closse River (coming from the East) flows on the east shore of the northern part of this lake;
• 6.3 kilometres (3.9 mi) southerly, crossing the southern portion of Maricourt Lake (Macho River), to the confluence of the river.^[2]

The Macho River discharges at the bottom of a bay on the north shore of Berthelot Lake (elevation: 385 metres (1,263 ft) which empties onto the north shore of the Mégiscane River The latter is a tributary of Parent Lake (Abitibi) .This latter lake empties into the Bell River, a tributary of Matagami Lake. in turn flows into the Nottaway River, a tributary of the southeast shore of James Bay.

This confluence of the Macho River with Berthelot Lake (Mégiscane River) is located opposite the confluence of the Berthelot River (Mégiscane River); upstream of Rapides Manidioc and the confluence of the Achepabanca River; and downstream of the confluence of the Whitegoose River. Specifically, the Macho River flows to:

• 62.5 kilometres (38.8 mi) East of the confluence of the Mégiscane River with Parent Lake (Abitibi);
• 36.1 kilometres (22.4 mi) north of the former Gagnon-Siding Railway Station of the Canadian National Railway;
• 86.8 kilometres (53.9 mi) north-east of the village center of Senneterre;
• 51.0 kilometres (31.7 mi) west of Gouin Reservoir.

• Nottaway River, a watercourse
• Matagami Lake, a body of water
• Bell River, a watercourse
• Parent Lake (Abitibi), a body of water
• Mégiscane River, a watercourse
• Gouin Reservoir, a body of water
• Maricourt Lake (Macho River), a body of water
• Berthelot Lake (Mégiscane River), a body of water
• Senneterre, a city
• La Vallée-de-l'Or Regional County Municipality (MRC)
• List of rivers of Quebec