As a teenager she suffered spinal illness and underwent complex surgery, which she finally overcame at the age of 21, allowing her to move to Jerusalem to study biology and zoology at the Hebrew University.
After her studies, she worked first as a science teacher and then as a research assistant at the university. In Jerusalem she also met Reuven Rivlin, a young lawyer and Likud activist: they married in 1971 and raised three children and seven grandchildren.
Mrs Rivlin was rarely publicly involved in her husband’s political career, though as wife of the then-Knesset Speaker, she regularly appeared by his side.
She expressed her trenchant views in private, especially regarding her husband’s political rivals within Likud, including Prime Minister Benjamin Netanyahu, but never made public political statements.
In 2007, after four decades of work at Hebrew University, she returned as a pensioner to study art history there.
When Mr Rivlin was elected president in 2014, she wanted to continue living in their flat in Jerusalem’s Yefe Nof neighbourhood, but moved to the President’s official residence at the Shin Bet’s insistence.
She planted a community vegetable and herb garden on the residence’s grounds, which she tended together with schoolchildren from across Israel.
The First Lady also founded a President’s prize for young Israeli poets and her posts on Hebrew books she enjoyed were a regular feature on the presidency’s official Facebook page.
She wore the trappings of office lightly, saying “I’m here with a lover” of her bodyguard at a school reunion she arrived at last year, and was often seen at Jerusalem culture venues, sitting in the audience without any fanfare.
Following the lung transplant, her condition improved for a short while and Mrs Rivlin was well enough to read David Grossman’s latest novel.
But as her situation deteriorated, relatives and friends read to her in shifts. In recent weeks, President Rivlin shuttled between the hospital and the residence, where he received the party leaders for talks on forming a government.
Announcing her passing, the Rivlin family said it “wishes to thank the people of Israel and religious leaders who have continued to be concerned about Nechama’s welfare, who have sent letters and children’s drawings to the hospital and the President’s Residence and who have prayed for her recovery every day, every hour.”
