The oldest parts of the church survive in the two westernmost bays of the nave, built as Örtomta's original Romanesque church with a west tower and narrower chancel. Transepts were added around the mid-1200s, their rounded openings cut using stonework techniques resembling those seen in Linköping Cathedral, and dedicated to Saint Anne and Saint Olof.
In the 1400s the original chancel was demolished and replaced by a larger one matching the nave's width, fitted with ribbed brick vaults painted with decorative ornament; a partly damaged Latin inscription has been read as recording completion in 1470. Lightning struck the church in 1652, causing severe fire damage. In 1730 Count Johan Banér of Ekenäs slott funded a further extension of the chancel eastward, building a burial vault for his family beneath it.
The church's bells were moved into the stone tower in 1739, but the ringing proved too powerful for the tower walls, which began to crack; the bells were later rehoused in a new freestanding bell-frame in the churchyard. The medieval tower itself was demolished in the winter of 1829–1830 and replaced by a timber porch. Further rebuilding between 1854 and 1856 lowered all the roofs to their present height and standardised the windows as round-arched openings, giving the exterior its current, largely uniform appearance and erasing most outward traces of its medieval origins.