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As assessed by intravital fluorescence microscopy, rolling and the firm adhesion of polymorphonuclear neutrophil leukocytes (PMNs) gave similar results in the Sham\u2009+\u2009IR and OVX\u2009+\u2009IR groups in the tibial periosteal microcirculation during the 3\u2010h reperfusion period after a 60\u2010min tourniquet ischemia. Postischemic increases in periosteal PMN adhesion and PMN\u2010derived adhesion molecule CD11b expressions, however, were significantly reduced by IPC (two cycles of 10\u2032\/10\u2032) in Sham animals, but not in OVX animals; neither plasma free radical levels (as measured by chemiluminescence), nor TNF\u2010alpha release was affected by IPC. E2 supplementation in OVX animals restored the IPC\u2010related microcirculatory integrity and PMN\u2010derived CD11b levels, and TNF\u2010alpha and free radical levels were reduced by IPC only with E2. An enhanced estrogen receptor beta expression could also be demonstrated after E2 in the periosteum. Overall, the beneficial periosteal microcirculatory effects of limb IPC are lost in chronic estrogen deficiency, but they can be restored by E2 supplementation. This suggests that the presence of endogenous estrogen is a necessary facilitating factor of the anti\u2010inflammatory protection provided by limb IPC in females. The IPC\u2010independent effects of E2 on inflammatory reactions should also be taken into account in this model. \u00a9 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. 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