Which supplement is linked to rare cases of liver toxicity and is used for menopause symptoms?

• A. Garlic
• B. Melatonin
• C. St. John's Wort
• D. Black cohosh

Answer: (D)

Herbal remedies for menopausal symptoms carry safety considerations because rare but serious liver injury has been reported with one in particular. Black cohosh is used to relieve vasomotor symptoms like hot flashes, night sweats, and mood swings, but there have been case reports and pharmacovigilance signals noting hepatotoxicity from this supplement. The liver injury can present after weeks to months of use and may show up as fatigue, jaundice, dark urine, abdominal pain, or elevated liver enzymes, which is why monitoring and prompt discontinuation are advised if symptoms arise. The other options don’t share this specific association with menopause treatment and liver toxicity in the same way: garlic isn’t a standard menopause remedy, melatonin is used mainly for sleep, and St. John’s Wort is focused on mood with notable drug interaction risks and less of a clear link to menopause symptoms. So the supplement linked to rare liver toxicity and used for menopausal symptoms is black cohosh.