Objective To investigate the incidence and the degree of symptom distress in breast cancer patients undergoing endocrine therapy，and to construct a contemporaneous symptom network to identify the core symptoms and symptom clusters，so as to provide references for precise symptom management. Methods A convenience sampling method was used to select breast cancer patients undergoing endocrine therapy in outpatient clinics and day wards of a tertiary hospital in Baoding City from February 2023 to November 2023，and a total of 330 patients were included. The Chinese Breast Cancer Prevention Trial Symptom Scale（C-BCPT） was used to assess the symptoms of the patients. The principal component analysis was used to extract the symptom clusters，and the symptom network was construct by R language，and the centrality index was calculated. Results Symptoms that distressed more than 50% of patients were fatigue （60.0%），weight gain （60.0%），hot flashes（60.0%），and joint pain（52.1%），which were also the top four symptoms with the highest degree of distress. Cognitive/fatigue symptom cluster，musculoskeletal/vasomotor symptom cluster，and sexual problems symptom cluster were extracted. In the symptom network，difficult to concentrate（rS=1.09） was a symptom with the highest strength，cognitive/fatigue symptom cluster（rS=0.92） was a symptom cluster with the highest average strength，and the top three symptoms with the highest bridge strength were fatigue（rBS=0.29），weight gain（rBS=0.23），and lack of interest in sex（rBS=0.22）. Conclusion There are various symptoms in breast cancer patients undergoing endocrine therapy. Difficulty in concentration is the core symptom for breast cancer patients，the cognitive/fatigue symptom cluster is the core symptom cluster，fatigue，weight gain，and lack of interest in sex are the bridge symptoms in the network analysis. Healthcare professionals can develop precise interventions for the core symptoms，symptom clusters and bridge symptoms so as to improve symptom management efficiency and outcomes.