Eutrophication in coastal waters caused by excess nutrient inputs has occurred widely on a global scale. Due to the rapid economic development over the last four decades, most of the Chinese coastal waters have experienced a eutrophic process. Major observed trends of coastal eutrophication include two periods, a slow development from the 1970s to 1990s and a fast development after 2000, with major contributions of increased nitrogen (N) and phosphorus (P) from river inputs, atmospheric deposition, and submarine groundwater discharge (SGD). Nutrient composition and stoichiometry have been significantly changed, including increased ammonium, bioavailable organic N and P, and asymmetric ratios between N, P and silicate (Si). Most of these changes were related to the rapid increases in population density, fertilizer application, sewage discharge, aquaculture and fossil fuel combustion, and have resulted in distinctly increased harmful algal blooms. Coastal eutrophication combined with the effects of climate change is projected to continually grow in coming decades. Targeted research is therefore needed on nitrogen reduction and control, potential adaptation strategies and the consequences for ecosystems and economic sustainability.