This study classifies Mediterranean marine protected areas (MPAs) according to the combined result of pressure level and protection. Six major marine environment pressures were considered: pressures from fish farms, fishing, marine litter, pressures from marinas, pollution from maritime transport, and climate change. MPA protection was assessed through legal protection and management effort. Most MPA area in the Mediterranean is under relatively high pressure level and afforded low protection. Inshore areas show higher pressure levels. Five marine ecoregions, nine countries and nineteen MPA designation categories have over 50% of their MPA area under major concern. The mean number of cumulative pressures occurring in priority MPAs ranges between three and four, although the mean combined intensity of those pressures is low. However, these figures are most likely underestimated, especially for the southern Mediterranean. The most concerning pressures to MPAs regarding extent and intensity were: climate change, fishing and pollution from maritime transport.