Metals and metalloids tainting sediments is an eminent issue, predominantly in megacities like Mumbai and Navi Mumbai, requiring an exhaustive examination to identify metal levels in river bodies that serve various populations. Thus, utilising pollution indices, multivariate analysis, and health risk assessment studies, we propose a novel investigation to examine the metal content in the Ulhas River sediments, a prominent agricultural and drinking water supply (320 million-litre per day) near Mumbai in Maharashtra, India. The eleven metals and metalloids (As, Cd, Cr, Cu, Fe, Hg, Mn, Ni, Pb, Se, and Zn) were examined monthly from 10 stations totaling 120 sediment specimens from October 2022 to September 2023. Investigations revealed that average values of Cr, Cu, Hg, and Ni exceeded Australian and New Zealand Environment and Conservation Council and Agriculture and Resource Management Council values, while all metals exceeded World surface rock average limits except As. Various pollution indices showed that upstream sites had none to low level contamination, whereas downstream locations had moderate to considerable contamination, suggesting anthropogenic influences. Furthermore, multivariate analysis including correlation, cluster, and principal component analysis identified that sediment pollution was mostly caused by anthropogenic activities. Lastly, health risk assessment indicated Fe was non-carcinogenic to children, whereas Cr and Ni were carcinogenic to children and adults, with children being more susceptible. Thus, from the findings of the study it is clear that, despite low to moderate pollution levels, metals may have significant repercussions, thus requiring long-term planning, frequent monitoring, and metal abatement strategies to mitigate river contamination.