Freshwaters and especially lake ecosystems, when in good status, provide multiple benefits and services to societies, making them essential for assisting in reaching several Sustainable Development Goals (SDGs). However, the ability of these ecosystems to provide services is not unlimited but is dependent on the lake-type, exploitation extent and its full functioning. Mediterranean lakes are the most threatened ecosystems and of particular importance, regarding their values and services such as flood protection, biodiversity hosting, resources provision, water quality improvement, aquifer or groundwater storage and recharge. At the same time multiple pressures, usually synergistic, threaten their integrity and biodiversity, imposing new challenges to lake ecosystem management and restoration. Thus, lake managers are required to address and mitigate the impact of multiple pressures and to disentangle such effects by selecting eco-friendly practices, without affecting the lakes’ current uses. It is important that managers should provide adaptive management plans to respond before important environmental thresholds threaten human livelihoods, and ecosystem sustainability. The adoption of Ecosystem Services (ES) Approach in water management offers an added value by providing a framework for conceptualizing the link between the environment per se and the ways people value and ‘use’ it. This chapter aims to advance our knowledge on how to integrate the ES concept into lake management and governance, how these numerous ES are related to basic limnological functions, and how these are linked to biodiversity and water security.