Although 70% of estrogen receptor (ER)-positive breast cancer patients benefit from Tamoxifen therapy, the developing resistance to Tamoxifen leads to high rates of metastasis and poor prognosis. Propofol, a commonly used anesthetic, has been shown to inhibit the occurrence and development of breast cancer. However, its role in anti-endocrine resistance in ER-positive breast cancer remains unclear. In this study, we found that Propofol significantly promotes cell cycle arrest, induces apoptosis, and inhibits proliferation in Tamoxifen-resistant breast cancer cells. Furthermore, transcriptome sequencing analysis revealed 1065 differentially expressed genes (DEGs) between Propofol-treated Tamoxifen-resistant MCF-7 (MCF7-TR) cells and none-treated MCF7-TR cells. Gene ontology annotation enrichment analysis (GO), Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis (KEGG), and gene set enrichment analysis (GSEA) showed that Propofol affects the expression of genes located in the plasma membrane and cell periphery, mainly regulating signals involved in cell cycle regulation, immune response modulation, and metabolism. Our results provide new insights into the mechanism by which Propofol controls resistance to Tamoxifen in breast cancer progression and offer a theoretical basis for clinical treatment.