The last of five prostitutes found dead during a 10-day spell had neck injuries, a jury heard.
Paula Clennell, 24, died after her neck was "compressed", a pathologist told Ipswich Crown Court.
Dr Nat Cary said internal examinations showed bruising to Miss Clennell's neck muscles.
She had also been under the influence of heroin and cocaine when she died, he said.
Dr Cary was giving evidence at the trial of a forklift truck driver accused of killing the five women.
Steve Wright, 49, of Ipswich, Suffolk, denies murdering Miss Clennell, Gemma Adams, 25, Tania Nicol, 19, Anneli Alderton, 24, and Annette Nicholls, 29.
Jurors have heard that the naked bodies of the five women, who all worked as prostitutes in Ipswich, were found at remote locations near the town between December 2 and December 12, 2006.
Dr Cary told the court that he thought all five could have been asphyxiated - possibly after being put in some form of headlock.
