Agricultural landscapes in the Mediterranean region may be considered as social-ecological systems that are important for biodiversity conservation whilst contributing to a wide range of ecosystem services. This literature review aims to identify the current state and biases of ecosystem service assessment in agroecosystems within the Mediterranean region, evaluate pressures impacting on agroecosystems and their services, and practices that promote ecosystem service synergies in Mediterranean agroecosystems. A total of 41 papers were selected for analysis from a set of 573 potentially relevant papers. Most of the selected papers focused on supporting, regulating and provisioning services, and mostly assessed ecosystem structure or services in the European Mediterranean context. Literature about benefits and values ascribed to by communities and stakeholders remain limited. Results presented here support the notion of multifunctional Mediterranean agroecosystems and multiple synergies were recorded in this review. Publications dealing with pressures that related to agricultural practices and demographic changes were in the majority and impact on different cropping systems. This review highlights the need to carry out integrated ecosystem service assessments that consider the multiple benefits derived from agroecosystems and which may be used to identify management practices that lead to the improvement of ecosystem services capacities and flows.