Why Does Endometriosis Come Back After Surgery? The Gut, Estrobolome, and Bioenergetic Mechanism — What restoration looks like

A treatment approach anchored in the Host Capacity Model framework looks substantially different from standard endometriosis care. The conventional management remains appropriate where indicated: surgical excision when needed, hormonal suppression as the patient and her gynecologist decide, pain management. The upstream work proceeds in parallel. The sequence: First, identify the dominant upstream drivers in the specific patient. Through systematic case review, determine whether the estrobolome activity is the dominant driver, the LPS-driven systemic inflammation, the mast cell mechanism, the mitochondrial dysfunction, the iron handling, or some combination. Most cases involve multiple drivers; one is usually dominant. Second, address the gut substrate that produces the elevated beta-glucuronidase activity. This includes addressing any underlying SIBO (per the framework in the recurrent SIBO article ), reducing the dysbiotic taxa that produce excess beta-glucuronidase, supporting the recolonization of the obligate anaerobic core that supports healthy mucosal function, and reducing the inflammatory drivers that produced the dysbiosis in the first place. Third, restore the regulatory cofactor pool. NAD+ precursor supplementation addresses the CD38-driven NAD+ depletion. Attention to methylation cofactors and B-vitamin status. Iron status interpreted through the lens of the broade