The Western Plaguelands are located in northern Lordaeron, wedged between Tirisfal Glades to the west, the Eastern Plaguelands to the east, and the Alterac Mountains to the south. It is filled with a smoky gray mist and the creatures here are blighted and sick, angrily attacking anyone who wanders too close with surprising ferocity. The land is also home to countless undead who infest the ruins of Andorhal, the four cauldron fields, and Sorrow Hill. The Scarlet Crusade has a significant holding in and around Hearthglen to the north, and the Alliance has settled in the small Chillwind Camp to the south.

Like their eastern counterparts, the Western Plaguelands were once fertile and beautiful but are now gray, blighted and noxious. Undead wander the land and haunt the abandoned towns and farmsteads. The largest Scourge city here is Andorhal, beneath which is an underground complex housing the undead's School of Necromancy. The Scarlet Crusade strikes against the Scourge from Hearthglen. The only place of any sanity in the Western Plaguelands is Uther's Tomb, a consecrated monument to the fallen hero Uther Lightbringer.

The area now called the Western Plaguelands was a beautiful forested farmland to the east of the Capital City of Lordaeron. It was the lush eastern belt of the Tirisfal Glades stretching from Lordaeron in the west to the Darrowmere Forest to the east. The town of Hearthglen was the seat of the regional administration, while the town of Andorhal was the center of grain distribution in the Kingdom of Lordaeron's northern provinces.

Knowing that the quickest way to spread the Plague of Undeath would be via the grain exported from Andorhal, the necromancer Kel'Thuzad and his Cult of the Damned infected the grain with the Plague, and set up four massive plague cauldrons in the fields of the area's four largest farmsteads. As Lordaeron collapsed, the farmlands and the forests began to die. The trees in the Plaguelands pulsate with tumor-like growths, and the needles of the pines are a sickly brown. With the Kingdom collapsed, the Scarlet Crusade attempted to salvage what little of their lands remained, taking possession of Mardenholde Keep in Hearthglen as a regional headquarters. The Argent Dawn also has a presence here, including setting up a camp near the overcrowded cemetery at Sorrow Hill for the Alliance, aiding the Forsaken in reinforcing their bulwark on the eastern border of Tirisfal, and sending soldiers of the Horde into battle against the Scourge.

Despite being where the Plague took hold in Lordaeron, the Western Plaguelands are in surprisingly better condition (though still quite dead) than the Eastern Plaguelands. It is clear that the land is trying to resist the Plague with what little it has left.