Joanna Yeates fought a desperate battle for life as she suffered 43 injuries at the hands of her neighbour, a court has heard.
Miss Yeates, 25, was said to have suffered a slow and painful death as she was strangled by "cold and calculated" killer Vincent Tabak.
Tabak kept his crime secret for more than six weeks before confessing to a prison chaplain, prosecutors claim.
Tabak, 33, was said to have used his height and build to overpower Miss Yeates's 5ft 4in frame at her flat in Clifton, Bristol. She fought for her life for some time as Tabak pinned her to the floor by her wrists, Nigel Lickley QC told Bristol Crown Court.
"There was a violent struggle by Miss Yeates to survive," he said. "He might have let go but he did not. He knew that Miss Yeates was in pain and struggling to breathe. We suggest he did not panic or lose control. He was controlled and calculated."
Mr Lickley explained that a post-mortem examination carried out by Dr Russell Delaney found Miss Yeates died as result of compression to the neck.
"The overall pattern of injuries indicate an episode of manual compression of the neck that is known as strangulation," Mr Lickley told the jury. "The injuries mean that Miss Yeates was alive when the injuries to her neck took place and death was not instantaneous. In other words it took some time and sufficient force was used to kill her."
Mr Lickley said other injuries to her face, side of her head and upper limbs show contact with a roughened surface while she was still alive. The injuries to the front and the back of her indicated two hands being used to kill her.
The court had already heard how within minutes of "squeezing the life out" of Miss Yeates, Tabak sent his girlfriend a text message: "Miss you loads. It's boring here without you Vxx." He also went shopping in Asda with her body in his car boot less than two hours after the killing on December 17.
Dutch engineer Tabak - who has admitted manslaughter but denies murder - left her corpse on a snowy verge with her jeans still fastened and her pink top partially pulled up over her head.