Abstract Quasi-periodic eruptions (QPEs) are luminous X-ray outbursts recurring on hour timescales, observed from the nuclei of a growing handful of nearby low-mass galaxies. Their physical origin is still debated, and usually modeled as (a) accretion disk instabilities or (b) interaction of a supermassive black hole (SMBH) with a lower mass companion in an extreme mass-ratio inspiral (EMRI). EMRI models can be tested with several predictions related to the short- and long-term behavior of QPEs. In this study, we report on the ongoing 3.5 yr NICER and XMM-Newton monitoring campaign of eRO-QPE1, which is known to exhibit erratic QPEs that have been challenging for the simplest EMRI models to explain. We report (1) complex, non-monotonic evolution in the long-term trends of QPE energy output and inferred emitting area; (2) the disappearance of the QPEs (within NICER detectability) in 2023 October, and then the reappearance by 2024 January at a luminosity of ∼100× fainter (and temperature of ∼3× cooler) than the initial discovery; (3) radio non-detections with MeerKAT and Very Large Array observations partly contemporaneous with our NICER campaign (though not during outbursts); and (4) the presence of a possible ∼6 day modulation of the QPE timing residuals, which aligns with the expected nodal precession timescale of the underlying accretion disk. Our results tentatively support EMRI–disk collision models powering the QPEs, and we demonstrate that the timing modulation of QPEs may be used to jointly constrain the SMBH spin and disk density profile.