Why Does Endometriosis Come Back After Surgery? The Gut, Estrobolome, and Bioenergetic Mechanism — The clinical signature that suggests the framework applies

The endometriosis cases that benefit most from a Host Capacity Model approach share specific features. These features identify the cases where the upstream gut-bioenergetic mechanism is dominant. They include: A history of significant gastrointestinal symptoms preceding or accompanying the endometriosis. Bloating, food sensitivities, IBS-pattern bowel changes, postprandial fatigue. Concurrent or sequential SIBO, particularly recurrent SIBO that responds incompletely to standard treatment. MCAS-spectrum symptoms: flushing, food reactions, environmental sensitivities, perimenstrual symptom flares. Fatigue that is disproportionate to the visible pelvic disease. Brain fog that worsens with cycle changes. A history of significant antibiotic exposure preceding the onset of severe periods. Family history of estrogen-related conditions (endometriosis, fibroids, breast cancer, ovarian conditions). Response to dietary interventions that is more substantial than the disease severity would predict. Worsening of disease in perimenopause despite the expected decline in estrogen, suggesting that local mechanisms beyond ovarian estrogen are dominant. A patient who has most or all of these features is a case where the framework is likely to add value. A patient with none of them may have endometriosis driven by different upstream factors (genetic, immunologic, or developmental), in which case t