Medication-Associated Xerostomia and Oral Symptom Burden in Midlife Women: A Drug Safety Perspective Across the Menopausal Transition

Background/Objectives: Medication-associated xerostomia is a clinically relevant adverse effect, but its contribution to oral symptom burden in midlife women remains insufficiently characterized. This study investigated the association between xerogenic medication exposure and xerostomia burden across the menopausal transition and whether this association extended to broader oral symptoms. Methods: This cross-sectional study included 306 Romanian women aged 45–65 years. Medication exposure was assessed in two complementary ways: a medication-list-derived definition, in which reported medicines were coded into therapeutic classes with recognized xerogenic potential (n = 54; 17.6%), regarded as the pharmacological reference measure, and participant-reported use of medication potentially associated with dry mouth (n = 39; 12.7%), which additionally reflects patient recognition of xerogenic exposure. Outcomes were a six-item xerostomia symptom score (XSS-6; 0–18) and a nine-item oral symptom score (OSS-9; 0–27), both derived from the MMBQ-44. Associations were evaluated using two-part models adjusted for age, menopausal stage, body mass index, smoking, medication burden, and psychological symptom burden, with complementary sensitivity analyses. Results: Xerostomia symptoms were more frequent among women reporting xerogenic medication (94.9% vs. 71.5%; unadjusted OR 7.36, 95% CI 1.73–31.30), and participant-reported exposure remained associated with greater XSS-6 severity after full adjustment (+1.28 points, 95% CI 0.22–2.34). With the medication-list-derived definition, unadjusted associations were present (rate ratio 1.50, 95% CI 1.08–2.10) but attenuated to near-null estimates after full adjustment (severity difference 0.06 points; rate ratio 1.17, 95% CI 0.79–1.71). Psychological symptom burden was independently associated with both outcomes, and no independent association with OSS-9 was observed for either exposure definition. Agreement between definitions was moderate (85.3%; Cohen kappa 0.43); only 24/54 (44.4%) women identified from medication lists recognized taking medication capable of causing dry mouth. Conclusions: Pharmacologically defined xerogenic exposure showed weak independent associations with xerostomia burden after full adjustment, whereas the stronger associations observed for participant-recognized exposure may partly reflect symptom-driven awareness and should be read as an upper bound. Limited recognition of xerogenic exposure points to a medication-safety communication gap. Prospective studies with verified medication exposure, dose and duration data, and objective salivary measurements are needed to clarify causality.