Organisms in polluted environments are typically exposed to a complex mixture of chemical contaminants. The great concern about the health of aquatic ecosystems has led to the increased use of biomarkers over the past years. The aim of this work was to review the papers published from 2000 to 2015, which used biomarkers to assess the health of aquatic ecosystems in Brazil. A research resulted in 99 eligible papers. More than 80% of studies were conducted in the states of São Paulo and Rio Grande do Sul. Approximately 63% of studies used fish as bioindicator, whereas the micronucleus test and biochemical analyses were the most used biomarkers. A multibiomarker approach was used by 60.6% of studies, while 39.4% used one single biomarker. Furthermore, 68% were field studies and more than 75% of these used control animals sampled at reference sites. A relationship between the biomarker responses and pollution was reported by 87% of studies; however, 43.4% of studies analyzed only one sampling period, limiting comparisons and comprehension about possible seasonal variations. This review evidenced some weak points in studies using biomarkers in Brazil, especially related to the lack of studies in two important biomes (the Pantanal and the Amazon Rainforest) and experimental designs (small sample size, sampling in one single period, use of one single biomarker). Thus, future studies should consider mainly the use of multiple biomarkers, greater sample size, seasonal sampling and water physicochemical parameters to better diagnose the health of aquatic ecosystems.