Widespread streamflow droughts can pose substantially greater societal challenges than spatially less extensive events because of the complex realities of trans-regional water management. In a warming climate, drought spatial extent may change along with changes in underlying hydro-meteorological contributors. Here, we assess changes in streamflow drought spatial extent over the period 1981–2018 across the conterminous United States, and how the importance of potential hydro-meteorological contributors has changed over time. We first derive a monthly time series of drought spatial extent and look at trends in streamflow drought spatial extent. We then determine the spatial percentage ‘overlap’ of precipitation droughts, temperature anomalies, snow-water-equivalent deficits, and soil moisture deficits with the area under streamflow drought to look at the changing influence of these contributors on spatial extent. Our results show that (1) the spatial extent of droughts has increased, mainly because of increases in the extent of small droughts; (2) streamflow drought extents overall substantially overlap with soil moisture deficits and the relationship of drought to precipitation and temperature anomalies varies seasonally; and (3) the importance of temperature as a contributor to drought extent has increased over time. We therefore conclude that continued global warming may further increase drought extents, requiring adaptation of regional drought management strategies.