After the Second World War it absorbed the rival Birmingham Combination to become firmly established as the leading league in the area, but a gradual decline in its status began in the late 1950s and it now operates at a much lower level than in its heyday.

The one club which sent a representative to the meeting but was not invited to take part in the league, for unknown reasons, was Worcester Rovers.

[1] The 12 clubs competing in the league's inaugural season were Aston Victoria, Great Bridge Unity, Hednesford Town, Ironbridge, Kidderminster Harriers, Kidderminster Olympic, Langley Green Victoria, Oldbury Town, Smethwick Carriage Works, Unity Gas Department, Wellington St George's, and Willenhall Pickwick.

A number of clubs which had enjoyed success in the Birmingham Combination also joined the league, which was seen as a step up to a better standard of football.

[4] By the time competitive football was abandoned in 1939 due to the outbreak of the Second World War, the rival Birmingham Combination, which had not chosen to accept teams from such a wide area, had consolidated and come to be regarded as the region's top league.

[5] The Combination's committee then attempted to re-open the merger talks but, having just bolstered its ranks with six new members, the League was not interested.

[5] A year later, all of the Combination's 14 remaining clubs, with the exception of West Bromwich Albion's 'A' (third) team, left to join the League, which effectively absorbed its former rival.

[7] At the end of the 1957–58 season, Burton Albion and Nuneaton Borough left to join an expanding Southern League, followed a year later by Hinckley Athletic.

[8] In an attempt to consolidate the league decided to expel all remaining reserve teams, reducing to a single division of 22 clubs.

[9] Four years later it changed its name to the West Midlands (Regional) League to more accurately reflect its catchment area, which now included very few teams from Birmingham or its immediate environs.

[14] At the same time the catchment areas of the Regional League and the Midland Football Combination were increasingly converging, and by the early 1990s the standard of play and geographical coverage of the two competitions were considered to be almost identical.

Previously it has been sponsored by Sport Italia,[21] the Wolverhampton-based Express & Star newspaper,[22] and Black Country brewery Banks's.

[36] By the early 1960s, despite the league's decline in status, Kidderminster Harriers were still able to attract crowds of around 1,000 fans for home matches.

In the 1993–94 season Rocester averaged around 100 fans for home games, and several of the team's away matches drew crowds of less than 40.

Initially the league consisted of a single division Between 1915 and 1919 the competition was suspended due to the First World War.