Worms: Ultimate Mayhem is a 3D turn-based strategy game featuring content from both Worms 3D and Worms 4: Mayhem. The shift to 3D gameplay introduces new mechanics and tactical options compared to earlier 2D titles.

The game includes over 70 single-player missions and challenges, along with local and online multiplayer for up to four players across five different modes. It features fully destructible environments, customization options for characters and weapons, and support for Steam Achievements.

This version also includes updated visuals, gameplay improvements, and additional content, combining elements from two previous games in the series.