Twinflower is a perennial, and the evergreen leaves last some two years before being shed and replaced. It can spread by seed or vegetatively, the seeds being dispersed by animals and birds, whilst new shoots come from plants at least five years old. The plant is shallow-rooted, susceptible to both drought and fire, but it can re-establish itself on fire-damaged or disturbed ground. However, it is believed that the seeds do not survive for long within the seedbank. Twinflower has the ability to produce vegetative clones of itself, although these do not appear to be able to self-fertilise.