The HaPPI study: Better quality of life for people with endometriosis

Key Findings

The HaPPI trial is the first large randomised controlled trial to demonstrate that an endometriosis-specific telehealth CBT program can significantly improve health-related quality of life and reduce pain compared with an active education control.

At the end of the 8-week intervention, participants who received CBT experienced improvements in:

• Endometriosis-specific pain
• General health-related quality of life
• Menstrual pain
• Bowel pain
• Bladder pain
• Pain during sex
• Pain self-efficacy
• Pain catastrophising

Participants who received yoga also experienced improvements in menstrual symptoms and pain during sex compared with the education control group.

These findings support the inclusion of endometriosis-specific CBT as part of multidisciplinary care and suggest that yoga may be a valuable complementary intervention for symptom management.

Translation into Practice

A key aim of the HaPPI trial has been to translate research findings into clinical practice.

Professional training for the HaPPI yoga program has been developed and is now available for yoga practitioners. A clinician manual for delivering the HaPPI CBT program is also available to support wider implementation of the intervention in healthcare settings.

The findings have also been shared with clinicians through professional education, including the Monash University Endometriosis Masterclass, and have been presented at national and international scientific meetings.

The trial has also been featured by Jean Hailes for Women’s Health, highlighting the role of cognitive behavioural therapy in improving pain and quality of life for people living with endometriosis.

Publications

Study Protocol

Mikocka-Walus, A., Druitt, M., O’Shea, M., Skvarc, D., Watts, J. J., Esterman, A., Tsaltas, J., Knowles, S., Harris, J., Dowding, C., Parigi, E., & Evans, S. (2021). Yoga, cognitive behavioural therapy versus education to improve quality of life and reduce healthcare costs in people with endometriosis: A randomised controlled trial. BMJ Open, 11(3), e046603. https://doi.org/10.1136/bmjopen-2020-046603

Primary Outcomes

Evans, S., Skvarc, D., Esterman, A., Mackay, M. I., O’Shea, M., Van Niekerk, L., Druitt, M. L., Tsaltas, J., Knowles, S. R., Parigi, E., Stanley, K., Harris, J., Barber, M., Dober, M., Dowding, C., & Mikocka-Walus, A. (2025). Telehealth cognitive behavioural therapy improves health-related quality of life and pain in endometriosis: The Healing Pelvic Pain Intervention (HaPPI)—A randomized controlled trial. Human Reproduction Open, 2025(1), hoag006. https://doi.org/10.1093/hropen/hoag006

Participant Experiences

Dowding, C., Mikocka-Walus, A., Skvarc, D., O’Shea, M., Olive, L., & Evans, S. (2025). Sharing stories, building connections, and regaining control: A qualitative study of cognitive behavioural therapy for endometriosis and persistent pelvic pain. Counselling Psychology Quarterly. https://doi.org/10.1080/09515070.2025.2536559

Meet the team

The HaPPI study is conducted as part of Deakin Lifespan Institute in collaboration with Barwon Health and Monash Health.