Major objectives were to provide a comprehensive dataset on beach macro-litter for parts of the southern Baltic Sea and to analyse if the methodology is fully applicable and a suitable monitoring method in the Baltic. We carried out a regular macro litter beach monitoring (OSPAR methodology, 4 time a year) on 35 beaches along the German and Lithuanian Baltic coast over 2–5 years. Additional experiments addressed the subjectivity of the field surveys and spatio-temporal variability on different scales. We observed no seasonality of the data and a monthly compared to a 3-monthly sampling resulted in 3 times higher annual item numbers. Along the Lithuanian coast, the average number of items per survey varied between 138 and 340 and along the German Baltic coast between 7 and 404, with a median value of 47. All data showed a very high spatio-temporal variability. Using the Matrix Scoring Technique we assessed beach litter sources. With 50% tourism and recreation was the most important source. 3D–transport simulations helped to explain the minor role of shipping as a source and, compared to the North Sea, the low numbers of items on German Baltic beaches. Floating litter had a short duration time in the western Baltic Sea and offshore drift dominated. Further, the common regular beach cleanings reduced the potential for local litter accumulation and translocation. We suggest a monitoring system on 14 Baltic beaches in Germany and 2 in Lithuania and provide cost calculations. The analysis of macro-litter in cormorant nesting material and the search for beached dead animals did not show any result. We can conclude that the macro-litter beach monitoring method is less suitable for Baltic beaches and should only serve as a complementary method in combination with others.