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The Pearl River Estuary is in the geometric center of Guangdong-Hong Kong-Macao Greater Bay Area, which is one of the main battlefields to drive the high-quality development of China’s economy. This paper uses seven sets of typical satellite images in Pearl River Estuary for nearly half a century (from 1973 to 2021) to analyze the changes of coastline and sea reclamation. The results show that from 1973 to 2021, the total length of the coastline of the Pearl River Estuary increased from 240.09 km to 416.00 km, and that of the continental coastline from 186.87 km to 246.21 km (but the length of natural coastline in the continental coastline decreased from 136.91 km to 15.17 km). In the same period, the total reclamation area of the Pearl River Estuary increased by 28,256.06 ha. Before 2012, the growth rate of reclamation was generally fast. After 2012, the reclamation in China has entered a period of reflection. With reclamation was strictly controlled in the new era, only the previously approved reclamation projects and national major projects have been guaranteed, which makes the average annual growth rate of the coastline length and the reclamation area in the region show a significant downward trend. The reclamation in early days was largely for agriculture and pond culture purposes, but is shifting to transportation, industrial development, and urban construction in recent decades. This study scientifically analyzes the coastline and reclamation changes of the Pearl River Estuary in the past half century, which has a very important reference value for the next step to formulate marine ecological protection and restoration strategies, and construct a new pattern of marine space development and protection.