A church is thought to have stood on this site from the 1100s, though no trace of that first building survives. Brick construction from the 1200s gradually replaced an earlier stone church, and the building was consecrated in 1271, dedicated to the Virgin Mary and John the Baptist. Over the following centuries it grew from a three-aisled basilica into the present five-aisled hall church, reaching its current footprint by 1517 after successive additions of chapels around the original nave.
The tower on the west front was completed around 1420. Its distinctive copper-clad spire, however, dates from 1694, designed by Nicodemus Tessin the Younger after fire destroyed an earlier spire in 1691; local residents reportedly worried it might collapse and petitioned the king before Tessin had the bracing removed. At roughly 92 metres, the tower remains the tallest structure in central Västerås.
The cathedral escaped much of the destruction of the Reformation, a survival partly credited to its sheltered position between river and ridges, and to Bishop Petrus Magni, who oversaw the transition to Lutheran worship while preserving much of the church's fabric and furnishings. Two major restorations later reshaped the interior: a Neo-Gothic remodelling in 1856–61 removed much Renaissance and Baroque decoration and even shifted the windows for symmetry, while a further restoration in 1958–61 introduced new flooring, a ceramic pulpit and modern stained glass, including windows by Fritiof Swensson and Randi Fisher.