Easily confused with : Broad-Leaved Helleborine with dark-red flowers rather than the more usual dirty greenish-purple, but that has a differing lip structure.

Not to be semantically confused with : Hellebores [plants with similar names but which belong to the Buttercup Family [Ranunculaceae] - nor with Red Helleborine (Cephelanthera rubra) [a plant with similar name belonging to a differing genus, but is still a Helleborine] which has flowers that are pinkish-red and of differing shape. Also, the stem of this Helleborine appears angular or square.

Hybridizes with : Broad-Leaved Helleborine (Epipactis helleborine) to produce Epipactis × schmalhausenii, the most convincing examples of which are to be found on Arnside Knot.

Some resemblance to : Marsh Cinquefoil (Comarum palustris), which has five beetroot-coloured actinomorphic (radially symmetric) petals and is found in wet places, and to Dusky Crane's-bill (Geranium phaeum) which grows in gardens and also has five actinomorphic beetroot-coloured petals [both of which belong to differing families].

There is great variation in the flowers, some specimens are small and cup shaped whilst others may have long elegant spreading sepals.

It grows only in limestone areas such as exposed limestone cliffs, in the deep grykes of limestone pavements or on the face of limestone quarries. It sets seed readily and efficiently.

Fungal associations of Helleborines Both Broad-Leaved Helleborine and the two Dune Helleborines (Epipactis dunensis ssp. dunensis) and Tyne Helleborines (Epipactis dunensis ssp. tynensis) have underground associations with the Ascomycetes group of fungi. Broad-Leaved Helleborine and Dark-red Helleborine (Epipactis atrorubens) may also associate with ectomycorrhizal fungi obtaining some nutrients from trees via the fungi these are connected to, stealing the nutrients from the fungi. Many Helleborines seem not to engage and swap nutrients with fungi, except perhaps for those occasional varieties of Helleborines which lack chlorophyll with which to photosynthesise but somehow manage; it seems that they ate least are able to thrive by obtaining substantial amounts of nutrients from fungi. The chlorophyll-less variety of Violet Helleborine (Epipactis purpurata var. rosea) is assumed to get sustenance from fungi.