What is the cause of lower abdominal cramps in an 18-year-old female with mildly elevated copper and ceruloplasmin levels, normal complete blood count (CBC), and normal liver enzymes, who is taking birth control and Lamictal (lamotrigine)?

Functional Ovarian Cysts: The patient's symptoms of lower abdominal cramps, combined with the use of birth control, suggest a possible relationship with her menstrual cycle. Functional ovarian cysts are common in women of reproductive age and can cause abdominal pain. The slight elevation in copper and ceruloplasmin levels may not be directly related to this condition but could be incidental or related to other factors.

Irritable Bowel Syndrome (IBS): Given the normal CBC and liver enzymes, and the presence of abdominal cramps, IBS should be considered. It's a common condition that can cause abdominal pain and cramping, often related to bowel movements or food intake.
Pelvic Inflammatory Disease (PID): Although the patient is on birth control, which reduces the risk of PID, it's still a possibility, especially if there's a history of sexually transmitted infections or other risk factors. The normal CBC does not rule out PID, as the infection can be localized.
Lamictal Side Effects: The patient is on Lamictal, an antiepileptic drug that can have various side effects, including abdominal pain. It's essential to consider whether the medication could be contributing to her symptoms.

Ectopic Pregnancy: Although the patient is on birth control, no method is 100% effective. An ectopic pregnancy is a life-threatening condition that requires immediate attention. The presence of abdominal pain and the patient's reproductive age make this a critical diagnosis not to miss.
Appendicitis: This condition can present with lower abdominal pain and requires prompt surgical intervention to prevent complications. The normal CBC and liver enzymes do not rule out appendicitis, as early in the disease process, these tests may be normal.
Ovarian Torsion: This is a surgical emergency that can cause severe abdominal pain. It's more common in women with ovarian cysts or other pelvic abnormalities.

Wilson's Disease: Given the slight elevation in copper and ceruloplasmin levels, Wilson's disease could be considered, although it's rare. This genetic disorder leads to copper accumulation in the body and can cause liver disease, neurological symptoms, and psychiatric problems.
Abdominal Angina: This condition, associated with chronic mesenteric ischemia, is rare and usually occurs in older adults. However, it could be considered in the differential diagnosis if other causes of abdominal pain are ruled out, especially if there are risk factors for vascular disease.