Discerning the influences of the El Niño Southern Oscillation (ENSO) and the North Atlantic Oscillation (NAO) on drought variability in the tropics during the Medieval Climate Anomaly (MCA) and Little Ice Age (LIA) will help to improve our understanding of climate system responses to internal and external forcing. Sediments from Lago El Gancho, Nicaragua, provide an ~1400 yr record of water balance (precipitation and evaporation) changes from a region that is sensitive to teleconnected Pacific and Atlantic ocean-atmosphere dynamics. Oxygen isotope values of ostracod carapaces (δ18Oostracod) are consistently low in El Gancho sediments between ca. A.D. 950 and 1250, indicating that wetter conditions prevailed during the MCA, a period of La Niña-like mean state conditions in the tropical Pacific, and a positive mean state of the NAO. The ~150 yr period between the MCA and LIA was marked by an abrupt shift to persistently drier conditions at a time of highly variable Pacific sea-surface temperatures, and a transition toward a more negative NAO phase. In sediment from ca. A.D. 1450 to the present, δ18Oostracod values increase, suggesting that drier conditions persisted through most of the LIA, a time of a relatively negative NAO phase and El Niño-like mean state conditions in the tropical Pacific. The long-term precipitation trends inferred from the El Gancho data are not entirely consistent with modern associations between precipitation in the circum-Caribbean region and the NAO, suggesting that present-day hydroclimatic shifts resulting from variability in synoptic climate patterns are dissimilar to changes resulting from teleconnected ocean-atmosphere dynamics that operated during the MCA and LIA.