Except for the Providence River and side embayments like Greenwich Bay, Narragansett Bay can no longer be considered eutrophic. In summer 2012 managed nitrogen treatment in Narragansett Bay achieved a goal of reducing effluent dissolved inorganic nitrogen inputs by over 50%. Narragansett Bay represents a small northeast US estuary that had been heavily loaded with sewage effluent nutrients since the late 1800s. The input reduction was reflected in standing stock nutrients resulting in a statistically significant 60% reduction in concentration. In the Providence River estuary, total nitrogen decreased from 100 μm to about 40 μm, for example. We tested four environmental changes that might be associated with the nitrogen reduction. System apparent production was significantly decreased by 31% and 45% in the upper and mid Bay. Nutrient reductions resulted in statistically improved water clarity in the mid and upper Bay and in a 34% reduction in summer hypoxia. Nitrogen reduction also reduced the winter spring diatom bloom; winter chlorophyll levels after nutrient reduction have been significantly lower than before the reduction. The impact on the Bay will continue to evolve over the next few years and be a natural experiment for other temperate estuaries that will be experiencing nitrogen reduction. To provide perspective we review factors effecting hypoxia in other estuaries with managed nutrient reduction and conclude that, as in Narragansett Bay, physical factors can be as important as nutrients. On a positive note managed nutrient reduction has mitigated further deterioration in most estuaries.